Periop Nursing Team Discovers Ringworm in X-Ray Garments

As part of a comprehensive focus on infection prevention in 2015, a perioperative nursing director in Indiana worked with her team to implement many process improvements including changes in cleaning protocols.

She was also driven to seek out less obvious sources of infection risk. After speaking with her staff, she found a common complaint—team members consistently brought up how “gross” and “smelly” some of the x-ray wearables were. Their investigation uncovered the highly contagious fungus, ringworm.

“It really hit me that this was something that we had overlooked,” she acknowledged. Looking for guidance through the CDC and The Joint Commission, the director found two important ideas:

• “The CDC talks specifically about how proper cleaning and disinfecting environmental surfaces are essential as two distinct and required steps. I learned that merely trying to use a wipe or spray on a soiled area will not get it clean.”
• “When The Joint Commission talks about how zero patient harm is achievable, and how high reliability organizations move beyond just striving to meet accreditation standards, this really hit home for me as a periop director because everyone is accountable for safety and quality.”

While a dedicated program for cleaning x-ray garments was not a governing body requirement in the health system, the periop team knew these wearables posed a serious contamination concern and addressing the issue formally was clearly the right thing to do.

A Formal Approach to X-Ray Garment Cleaning

Throughout 2016, the director led an initiative with her team to create a comprehensive x-ray garment cleaning and servicing program in both a community hospital system and at a Level 1 trauma center that is also an academic medical center.

Here are three key actions she and her team took to shape and implement the x-ray garment cleaning program:

1. Established scheduled cleanings and enhanced cleanings.

   Scheduled cleanings are deep cleanings with a full-scale decontamination process that is scheduled quarterly with a company that provides these dedicated services. Enhanced cleanings, as defined in AORN’s environmental cleaning guideline, are the measures taken in between scheduled cleanings throughout the year, such as wiping down telephones, computers, and light switches in between use.

   “I advocated the use of peroxide-based wipes to be used on x-ray garments in between scheduled professional cleanings provided by our cleaning company,” she says. She also notes that the contracted cleaning company provides free garment repairs, so that if there is a fabric tear, the garment comes back from cleaning with tears repaired.



2. Invited other department leaders for a system-wide discussion to implement the program.

   “This proved to be very helpful with internal dialogue and implementation strategies,” the director explained. “Though this topic was something I was passionate about for the perioperative services area, as I brought this topic and concern to Infection Prevention, Cath Lab, Endoscopy, Surgery Center, Pain Management, and other departments, it quickly became a system-wide initiative as the light bulb went off for everyone who also found the garments to be just as ‘gross’ as we found.”



3. Leveraged support from industry.

   “The garment cleaning company we contracted with has a national footprint and provided some references to us that we shared to open minds and conversations to our new cleaning initiative,” the director says. “Additionally, the fact that they are full service helped us as a system to get better organized and wrap our arms around the overall topic of lead wearables management.”

   She sees this work as a good example of The Joint Commission goal to have a constant focus on process improvement. “‘Zero Patient Harm’ means we don’t have to wait until it becomes a governing body mandate or a best practice recommendation to do the right thing for patient and staff safety.”

Free Resources for Members

AORN Journal Articles

Health Care Workers Use and Cleaning of X-Ray Aprons and Thyroid Shields

Back to Basics: Environmental Cleaning

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